Is There a Role for Surgery for Microprolactinomas?

The neurosurgical and endocrinologic treatment of prolactinomas has undergone significant advances in the past three decades. Because of medical progress, we are now confronted with two safe, effective approaches for treating prolactinomas. Transsphenoidal surgery for microprolactinomas carries a 90% cure rate while incurring minimal risks, and offers the only opportunity for endocrinologic and oncologic cure. Al-ternatively, treatment with bromocriptine and other dopaminergic agents also results in effective chemical control in greater than 90% of cases but requires lifelong treatment. Pharmacologic control of microprolactinomas remains the mainstay of treatment, but surgical indications include patients intolerant of medical treatment, failing medical therapy, and desiring pregnancy. Young patients wishing to avoid lifelong medical treatment may also be operative candidates. In these situations. surgery is a vital adjunct in the management of prolactinoma-secreting microadenomas.